AB0620 Do patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) need anticoagulants?
Authors: G. Tarasova, O. Egorova, A. Kolomeychuk, T. Reshetnyak
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have a two- to threefold greater risk of developing `thrombotic events. The expediency of thrombosis prevention in AAV continues to be discussed. The issue of prescribing anticoagulants (AC) is being discussed Objectives Retrospectively to analyze the parameters of routine blood clotting indicators in patients with AAV depending on receiving AC. Methods The study included 45 patients with AAV (15 -with granulomatosis with polyangiitis (GPA), 15 - microscopic polyangiitis (MPA), and 15 - eosinophilic granulomatosis with polyangiitis (EGPA), aged 23 to 73 years. Duration of the disease was in 6 patients had &lt;12 months, in 20 - 1-5 years, in 13 - 5-10 years, in 6 - &gt;10 years. High AAV activity were registered in 22 patients (BVAS &gt; 5)), 21 - low activity (BVAS &lt; 5) points), 2 - remission (BVAS 0-1 points). The VDI damage index in 5 patients was 0, in 30 – from 1 to 3, in 10 – &gt; 3 points. Glucocorticoids (GC) received 44: 78% of patients at a dose of 5-20 mg /day, 16% - &gt;20-40 mg / day, 4% - &gt;40-60 mg /day. AC 23 (51%) of 45 patients took AC. Blood clotting parameters were measured in 40 patients, including activated partial thromboplastin time (APTT), thrombin time (TT), soluble fibrin monomer complexes (SFMC), the number of platelets, 22 of them received AC. Results Thrombosis in the past history was registered in 8 (18%) patients, 7 of them continued taking AС. 16 patients received AC without thrombosis for prevention ones. Patients with GPA received AK more often than patients with MPA and EGPA (73%, 40%, 40%, respectively). AC were prescribed in 51% of patients. AC were prescribed to 51% of patients receiving GC at a dose of up to 20 mg/day and 44% of patients with a dose of GC above 20 mg/day. The appointment of anticoagulants was associated with the duration of the disease. With a disease duration of up to 1 year, AK was prescribed in 33% of cases, with a duration of &gt; 10 years - in 67% of cases. 59% of patients received AC with BVAS&gt;5, 38% of patients - with BVAS&lt;5. The following AC were prescribed to patients: direct oral AC (DOAC) in 16 (69.6%), unfractionated heparin (UH) - 1, low molecular weight heparins (LMWH) -6. LMWH (46%) and DOAC (54%) were prescribed with the same frequency to patients with BVAS&gt;5, while DOAC (87.5%) prevailed in patients with BVAS&lt;5. Hemorrhagic complications during the follow-up period were not registered in any case. Prolongation of APTT, TT was not significantly noted against the background of AC. I. There was a shortening of APTT in 14 (35%) of 40 patients, TT - in 1 (2.5%). An increase in the level of fibrinogen was recorded in 11 (27.5%) patients and in all 40 patients there was an increase in SFMC, which was an indicator of thrombotic readiness. Increased fibrinogen levels were associated with AAV activity (3 out of 11 had a history of thrombosis). Conclusion 1. Our retrospective analysis revealed that 51% of 45 patients with AAV received AC, they were more often prescribed with active AAV and more often with GPA. Our retrospective analysis showed that 51% of 45 patients with AAV received AС, more often with active AAV and more often with GPA. 2. DOAC was prescribed more often (in 70% of cases) compared to others. 3. The appointment of AC was associated with the duration of the disease. 4. The dose of GC did not affect the decision to prescribe AС. 5. Hemorrhagic complications during AС therapy were not observed in any case. Disclosure of Interests None declared